| 任大江,张兴胜,张志成,李放.老年腰椎椎管狭窄症患者术中硬膜囊撕裂位置及术中术后处理对策[J].脊柱外科杂志,2014,12(5):266-268. |
老年腰椎椎管狭窄症患者术中硬膜囊撕裂位置及术中术后处理对策  点此下载全文 (Fulltext) |
| 任大江 张兴胜 张志成 李放 |
| 北京军区总医院骨科, 北京 100700;北京军区总医院骨科, 北京 100700;北京军区总医院骨科, 北京 100700;北京军区总医院骨科, 北京 100700 |
| 基金项目： |
| DOI：10.3969/j.issn.1672-2957.2014.05.003 |
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| 摘要： |
| 目的 探讨老年腰椎椎管狭窄症患者手术发生硬膜囊撕裂的解剖学机制,比较撕裂位置及术中、术后处理对策.方法 回顾性分析2012年01月~2014年01月本院行腰椎后路手术的216例>70岁老年患者,记录患者一般资料、病程时间、术前诊断、手术方式和节段、术中硬膜囊撕裂的位置、术后脑脊液漏情况和处理方法以及并发症等.结果 共计151例患者入选,其中男89例,女62例,年龄70~93岁,平均78.12岁.术中发生硬膜囊撕裂共计34例,术后出现脑脊液漏23例,硬膜囊撕裂位置发生率硬膜囊后外侧>根袖>硬膜囊外侧>硬膜囊腹侧.术中采取硬膜囊缝合修补、明胶海绵压迫、生物蛋白胶粘合等处理,术后常规给予预防感染、神经根脱水、补液等治疗,均于术后3~10 d拔管,3~4周切口愈合,全部患者未出现严重并发症.结论 >70岁老年腰椎椎管狭窄症患者术中硬膜囊撕裂及术后脑脊液漏的发生率高于整体人群,且多位于硬膜囊后外侧及根袖,术中及时发现并仔细缝合或修补破损的硬膜、术后间断夹闭引流管、延长拔管时间能获得良好的效果. |
| 关键词：腰椎 椎管狭窄 硬模 撕裂伤 硬膜下积液 老年人 |
| Analysis of position and intra-post-operative measures of dural tear in elderly patients with lumbar spinal stenosis Fulltext |
| REN Da-jiang ZHANG Xing-sheng ZHANG Zhi-cheng LI Fang |
| Department of Orthopaedics, Beijing Military General Hospital, Beijing 100700, China;Department of Orthopaedics, Beijing Military General Hospital, Beijing 100700, China;Department of Orthopaedics, Beijing Military General Hospital, Beijing 100700, China;Department of Orthopaedics, Beijing Military General Hospital, Beijing 100700, China |
| Fund Project: |
| Abstract: |
| Objective To assess the anatomical mechanism, position, and surgical treatment of dural tear in elderly patients with lumbar spinal stenosis. Methods From January 2012 to January 2014, a total of 216 patients older than 70 years who underwent posterior lumbar interbody fusion due to lumbar spinal stenosis were retrospectively analyzed. The perioperative data were recorded as general information, duration of the symptom, preoperative diagnosis, surgical procedures, position of dural tear and intraoperative treatment, postoperative cerebrospinal fluid leakage and treatment, and complications. Results Intraoperative dural tear occurred in 34 patients of 151 enrolled patients, 23 patients with postoperative cerebrospinal fluid leakage. The comparison of the incidence of dural tear position was posterior-lateral side of dural sac > root sleeve > lateral side of dural sac > ventral side of dural sac. All the torn dural sac were treated with dural sac suture, gelatin sponge oppression, or fibrin glue adhesion. A Combining the methods of tight suture closure of fascia and delayed extubation, all the cerebrospinal fluid leakage stopped 3-10 d postoperatively, and no severe complications were observed. Conclusion The incidence of dural tear in elderly patients over 70 years old was higher than the overall population. The majority of the dural tear occurred in the position of posterolateral dural sac and root sleeve. Tight suture closure of fascia and delayed extubation could be helpful in the treatment of postoperative cerebrospinal fluid leakage. |
| Keywords:Lumbar vertebrae Spinal stenosis Duea mater Lacerations Subdural effusion Aged |
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